This week in the BMJ
Volume 330, Number 7490, Issue of 5 Mar 2005St John's wort is effective for moderate to severe depression
St John's wort is effective for moderate to severe depression
Hypericum extract WS 5570 (St John's wort) is at least as effective as paroxetine and is better tolerated as a treatment for moderate to severe depression. In a double blind, double dummy, reference controlled, multicentre non-inferiority trial, Szegedi and colleagues (p 503) randomised 251 adults to 900 mg/day of hypericum extract WS 5570 or to 20 mg/day paroxetine. The decrease in depression score 42 days later was more than 55% for patients taking St John's wort and less than 45% in the group taking paroxetine.
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Tacrolimus 0.1% matches potent steroids in eczema
Topical tacrolimus 0.1% is as effective in treating atopic dermatitis as potent corticosteroids and more effective than mild corticosteroids, and its side effects seem to be less serious, although it causes more skin burning. Ashcroft and colleagues (p 516) performed a meta-analysis of 25 randomised controlled trials including 6897 patients. They found no evidence that tacrolimus or pimecrolimus increases the risk of skin infection, but data are lacking for firm conclusions on whether they offer any advantage over corticosteroids in long term treatment of atopic dermatitis.
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What can the UK and US health systems learn from each other?
To learn from others is not a sign of weakness or failure; it is a demonstration of strength, say Quam and Smith (p 530). In the first in a series of articles, they examine why countries have not been good at learning from each other. Looking particularly at the UK and US health systems, they say that the United Kingdom would benefit from an institution such as the US Institute of Medicine and from building a network of high performance, low cost centres for complex procedures. The United States could improve its continuing medical education programmes and implement system-wide information technology.
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G8 summit could support global health equity
The meeting of the world's eight most industrialised countries in July this year could be used to enable developing countries to meet the WHO's millennium development goals, say Labonte and colleagues (p 533). They argue for the rights based approach to health and development and point out the availability and affordability of interventions to reverse declining health in poor countries—such as agreement on the migration of health professionals from sub-Saharan Africa. Cancelling debt and doubling of development aid are essential, and support for fairer trade rules that strengthen special and differential treatment for low income countries is also needed.
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Reviewing vitamin D deficiency
Serious deficiency of vitamin D has been identified as an important public health problem of elderly people. On page 524, Venning reviews recent developments in screening elderly housebound people for vitamin D deficiency and treating them with the aim of reducing the incidence of falls and fractures. From the available evidence on supplementation dosages, he concludes that at least 800 IU of vitamin D daily is needed to have an effect on falls.
Cardiac surgeons in northwest England perform well
All individual cardiac surgeons working in NHS hospitals in the North West health region perform to satisfactory standards. On page 506, Bridgewater (on behalf of all cardiac surgeons treating adults in the region) presents mortality data for named surgeons, adjusted for the severity of patients' condition, in two types of operation: coronary artery bypass graft and aortic valve surgery. Use of adjusted analysis should help to prevent risk-averse behaviour by surgeons and promote a culture of openness and transparency in healthcare delivery, say the authors.
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